The invention relates to storing cardiac rhythm information.
The most precise possible detection of cardiac rhythm information over sufficiently long periods of time and, if possible, in various physical and psychical situations of a patient, isxe2x80x94as has been known for a long timexe2x80x94an indispensable diagnostic aid for the cardiologist. In particular, monitoring of the temporal developments in the intervals between atrial events (the so-called PP intervals), as well as between ventricular actions(in particular the so-called RR intervals), as well as the time intervals between subsequent atrial and ventricular actions (of the PR intervals) or between ventricular and atrial actions (of the RP intervals), allows valuable conclusions as to specific arrythmiae.
Whereas in the out-patient and clinical practice of the cardiologist, the detection and recording of cardiac rhythm information is carried out, as a rule, by means of high-resolution ECG devices detecting as many details as possible so as to furnish to the physician valuable wave-shape data of the cardiac signals apart from the above-mentioned time intervals, the cardiac rhythm data detected on a patient over a certain period of time has to be processed and stored with a lowest possible expenditure in processing capacity and storage space for certain important applications. This requirement exists in particular with implanted cardiological devices which have been known and practically used for a prolonged period of time in the form of heart pacemakers for the treatment of bradycardia and/or tachycardia arrythmiae, as well as automatic defibrillators or cardioverters, or also as combined pacemakers/cardioverters or implanted drug dosing pumps.
Highly developed devices of this kind namely are equipped with one sensor or several sensors for detecting diagnostically relevant cardiac rhythm information in the patient""s body, and with associated signal shaping and processing steps, as well as an evaluation and control unit making a selection between a number of pre-programmed operation parameters or therapy variants, and therapy parameters with dependence on the detected cardiac rhythm information, according to an algorithm stored in the device. In particular, stimulation devices count among these which are automatically activated or switched from one mode to another, depending on the detected cardiac state of the patient. Thus, with certain types of automatic implantable defibrillators and antitachycardia pacemakers, a continuous detection of the time intervals between atrial actions and/or ventricular actions is carried out over a sufficiently long period of time, so as to be able to recognize life-endangering acceleration of the cardiac rhythm as early as at its initial stage, and to respond thereto by means of an appropriate stimulation therapy.
So as to be able to reliably detect the mentioned life-endangering states (in particular atrial or ventricular fibrillation) in the various known signs of disease, on the occasion of which the mentioned automatic cardiac rhythm correction means are used, detection and storing must extend over a considerable period of time or a considerable number of cardiac actions.
Even when only the time intervals between the P and/or R waves of the heart signal are detected and stored, and the detection, processing and storage of wave-shape data is completely renounced of, a considerable processor and storage capacity will be required for this purpose in the implanted device. This is of less importance with respect to the costs of the processors and memory modules which, as a matter of course, become higher with increased capacity demand. Rather, it is of importance with respect to the power consumption and therewith, the lifetime of the battery. Despite considerable progress in primary cell technology and corresponding capacity enhancements of the lithium cells used in implanted devices, the power consumption for processing and storing the time intervals between heart actions leads to an essential decrease in the battery life, and therewith of the device lifetime in known heart pacemakers,
Previously, several proposals have been made for compression methods which were specifically provided for a preprocessing of ECG information prior to processing or storing or, it general, for signal compression for implantable battery-operated devices.
Thus, in EP 0 263 599 A2, an ECG data compression is so proposed that a time marker is stored whenever the amplitude of the ECG input signal has changed by a certain amount as compared to the preceding recording date. In addition, art identification marker is stored upon a change of the sign of the increase of the ECG signal.
In EP 0 526 973 B1, the averaging for cardiac signals by means of a combined use of a temporal data compression and a sampling correlation is described,
In U.S. Pat. No. 5,724,032, a method and an apparatus for compressing and displaying the cardiac rate within the scope of a fetal cardiac rhythm monitoring are described. This solution is based on the principle of the xe2x80x9cmaximum absolute differencexe2x80x9d, i.e. the data sampled within a certain interval are compared with an initial value, and the value having the highest absolute difference as compared to the initial value is selected and stored as a representation of the data sampled in said interval. This method is directed to a high degree of maintenance of highly frequent signal components which are valuable within the scope of clinical diagnosis.
In EP 0 540 144 B1, a method and an apparatus for ECG data compression are described, wherein the RR time intervals between subsequent ventricular actions along with sampling values obtained at certain intermediate moments of time are stored. Hereby, a reconstruction of the shape of the R waves becomes possible.
From the Applicant""s DE 196 99 41 C2, a method and at device are known for storing signals in an implantable medical device, in particular for a compressed storing of ECG signal shape information. Hereby, the temporal signal course is sampled at predetermined time intervals and a subset of the sampling points is stored which is selected by means of a selection criterionxe2x80x94specifically the first differentiation of the temporal signal course as per time.
From EP 0 884 851 A2, a system and a method for data compression and for a non-linear sampling for implantable battery-operated devices are known which are also provided for an implantable pacemaker. The method resides essentially in the generation of a time-variable threshold value signal by means of which the physiological (analog) signal is compared with certain clock intervals. Hereby, a non-linear sampling is caused, and the thereby obtained data is finally subjected to a further compression.
From I. Provaznik, J. Kozumplik, xe2x80x9cWavelet transform in electrocardiography-data compressionxe2x80x9d Int. J. Med. Inf. 45 (1997), 111, an imaging diagnostic method on the basis of the Run-Length Encoding principle is known that is based on the decomposition of the ECG signal into a set of basic functions which completely cover the time-frequency domain. This method, as well as other, similar methods, is provided for ECG processing and recording in the out-patient and clinical area.
From U.S. Pat. No. 5,709,216, it is known to realize a data reduction of the measured values sampled in an implantable medical device by means of a method for variably resolving a data reduction, so as to reduce the storage space required. Hereby, for example, cardiac action intervals being physiological data, are converted into a digital value, whereby the digital representation is divided into portions, and individual subportions are allocated various resolution values.
From U.S. Pat. No. 5,819,740, a system and a method for compressing digitalized signals in implantable battery-fed devices are provided, by means of which especially an efficient telemetric transmission to an external receiver is supposed to be secured. In this solution, the method of determining a delta value or a difference between subsequent signal samples is used, whereby the largest of several determined delta values and the storage space required for the memorizing thereof is assessed, and the bit number and the herewith coded delta value are finally stored.
The invention is based on the object of providing an improved method which is simple and cost-efficient to implement, and an improved storage means of the generic kind, respectively, allowing for storing cardiac rhythm information with a significantly decreased expenditure in storage capacity and power consumption without an essential loss of information.
The above and other objects are accomplished in accordance with the invention by the provision of a method for storing from a temporal sequence of a plurality of individual cardiac events, cardiac rhythm information comprised of a sequence of time intervals between events of at least one of ventricular rhythm and atrial rhythm, comprising the steps of subdividing a time interval continuum of temporal distances between the events into time portions of a predetermined length, the time portions each being allocated a single-valued marker, the subdividing step ensuing in predetermined equal steps between 2 ms and 20 ms; providing each time interval detected along with a detection of the cardiac rhythm as one recording, with a marker of the time portion into which the time interval falls; assessing at least one of a number of recordings representing a count of recordings detected out of a predetermined total number of detected time intervals and a number of recordings representing a count of recordings belonging to each marker during a predetermined period of time; and storing the number of recordings and each of the markers which have been allocated from at least one of the recordings from the predetermined number of time intervals and the recordings during the predetermined period of time.
According to a second aspect of the present invention is provided a cardiac rhythm memory system comprising at least one memory means for storing detected cardiac rhythm information; at least one timing means for determining a storing period for the memory means; time interval discriminator means for allocating time intervals of the cardiac rhythm information detected within the storing period in each case to a plurality of predetermined, single-valued marked time portions, each time portion being subdivided into equal steps of between 2 ms and 20 ms; a plurality of recording counters corresponding to the plurality of the time portions for assessing a number of recordings representing a count of the recordings allocated to separate time portions during a storing period; and a plurality of memory portions corresponding to the plurality of time portions, each of said plurality of memory portions being allocated to one time position and being configured for storing the count of recordings.
According to a third aspect of the present invention is provided an implantable cardiac stimulation device for influencing the cardiac rhythm by means of electric stimulation pulses comprising a cardiac rhythm memory means including at least one memory means for storing detected cardiac rhythm information; at least one timing means for determining a storing period for the memory means; time interval discriminator means for allocating time intervals of the cardiac rhythm information detected within the storing period in each case to a plurality of predetermined, single-valued marked time portions; a plurality of recording counters corresponding to the plurality of the time portions for assessing a number of recordings representing a count of the recordings allocated to separate time portions during a storing period; and a plurality of memory portions corresponding to the plurality of time portions, each of said plurality of memory portions being allocated to one time position and being configured for storing the count of recordings.
The invention embraces the basic idea of storing the frequent occurrence of certain time interval values instead of each individual sampled time interval between certain cardiac actionsxe2x80x94hence, of all of the RR or PP or PR or RP intervals sampled in a certain period of time. It may be observed that hereby, in particular with a high temporal constancy of the cardiac rhythm, high compression effects can be achieved. This advantage is particularly valuable when a detection and reasonable evaluation of an untimely atrial or ventricular action (PAC and/or PVC) within a stimulated, hence xe2x80x9crigidxe2x80x9d cardiac rhythm is concerned.
The invention further embraces the idea thatxe2x80x94contrary to the skilled person""s current viewxe2x80x94the information loss related to this data compression is uncritical for the use of the cardiac rhythm information. This applies with a good approximation to the above-mentioned application case of monitoring untimely contractions between stimulated cardiac actions.
Finally, the idea is a part of the invention to detect the mentioned time intervals according to a predetermined xe2x80x9cpatterningxe2x80x9d of the time axis or (insofar as these were detected at a higher resolution), to allocate the detected values to such a pattern. By selecting the temporal resolution of the pattern, the compression rate can further be optimized with respect to the required information content of the cardiac rhythm information for a certain device function (e.g. triggering an antitachycardia stimulation or a cardioversion) For an essentially simultaneous (compressed) storage of various categories of time intervals, which must be distinguished from one another for the evaluation in the implantable device, one preferred embodiment of the method assigns in each case a single-valued category marker. Thus, expressed in a simplified manner, the time intervals between successive ventricular actions are assigned an xe2x80x9cRRxe2x80x9d marker, those occurring in the successive atrial actions are assigned a xe2x80x9cPPxe2x80x9d marker, the time intervals between an atrial and a subsequent ventricular action each are assigned a xe2x80x9cPRxe2x80x9d marker, and the intervals between a ventricular and a subsequent atrial action are assigned an xe2x80x9cRPxe2x80x9d marker. (It is understood that in the practical realization, digit values in a binary representation are used as the markers). Along with the inventive storing of the measured values allocated to portions of the selected time pattern, the category marker is then in each case carried along as well, and the counting of the recordings for the portions of the time pattern and the storing of the counted values ensues separately for the respective categories.
It is understood, however, that the method can be designed for certain types of cardiac rhythm correction devices, e.g. antibradycardia pacemakers or even certain defibrillators, to only detect a single type of cardiac events, and therewith to a single category of time intervals, thus allowing for dispensing of a category-related separate counting and storing. This fact simplifies the signal processing and storage, and hereby reduces the power required for this purpose, however, at the price of a reduced information content of the stored data.
The realization of the method ensues, such as has already been mentioned above, in a preferred manner by a combined time portion discrimination of the measured interval values relative to the predetermined time portions of the time pattern, and by an incrementation of a counter, which is allocated to that portion of the time pattern, into which the measured interval value was categorized. The term xe2x80x9ctime patternxe2x80x9d already implies that the division of the time continuum of the cardiac events into predetermined portions. Ls, preferably carried out with fixed steps. A part of a corresponding time pattern can, for example, comprise as time portions interval, lengths of . . . , 901-904 ms, 905-908 ms, 909-1002 ms, . . . , and hence is formed with a pattern pitch of 4 ms. It is understood that other pattern pitches, as wellxe2x80x94determining the tolerance range for the evaluation of intervals as being corresponding intervalsxe2x80x94can be used; from the present point of view, values in a range of between 2 ms and 20 ms are preferred.
From the present point of view, a method is of a particularly practical advantage, wherein pairs of RP and PR intervals are in each case recorded together, and are stored in pairs, whereby the category markers are carried along separately or an individual marker is allocated for the pair. This procedure is purposeful for the detection of the above-mentioned PVC or PAC within the scope of a stimulated cardiac rhythm.
According to the process aspects outlined above, a suitable memory means (in a broad interpretation of this term) exhibits time interval discriminator means for allocating the detected time intervals to portions of the time pattern, recording counters for the assessment of the recordings allocated to these time portions each in the storing period, and memory portions for recording the number of recordings. For determining the recording time interval a timer is provided. The latter interacts with a memory control in an appropriate manner so that the stored counted values allocated to the individual time portions are handled following the known FIFO storage principle.
Hence, with a continuous update of the storage count, in each case the oldest stored time interval value is to be cancelled, i.e. the count of the counter has to be decremented by 1 in that storage area, into which said interval value has entered. The realization of corresponding memory controls is within the scope of a skilled person""s proceeding, and is therefore here not described in more detail.
The realization of the invention can largely be carried out in terms of software, so that the functional units mentioned in the preceding paragraph are not to be understood as hardware components. Thus, the entire storage content can be deposited as a data word or a data string in an unstructured memory in terms of hardware, whereby the counted values allocated to certain portions of the time pattern, are represented by bit groups at certain positions of the data string.
The detection of cardiac events as such, i.e. the extraction of the P or R points from the analog cardiac signal, is known to the person skilled in the art and is not the subject matter of the present invention, so that it will not be considered here in more detail. The detection of the temporal distance between these cardiac eventsxe2x80x94hence, the time intervals concerned herexe2x80x94is also within the skilled personas proceeding, and therefore does not require any description here.